Spencer boils down the issues succinctly:

The White House says extending the length of these policies from 90 days to up to three years offers an affordable alternative for Americans who do not qualify for premium subsidies under the Affordable Care Act and cannot afford the premiums that come with the ACA’s mandatory coverages. The Trump rule allows ACA subsidies to be used to promote sales of short-term policies.

Those who want to curb the expansion say it will undermine the nation’s individual insurance market and health care reform by drawing away millions of the healthiest participants from the coverage pool.

It would be good news for consumers if these changes to STM plans last. I have said again and again that one of the main problems in American health care is the absence of price competition that would allow consumers to shop for health insurance products like they shop for other items—by comparing benefits, assessing costs, and making buying decisions that comport with their personal needs. More liberalized short-term medical insurance policies provide at least some of that flexibility in the insurance marketplace by providing less expensive coverage, albeit with fewer features.

Is short-term medical insurance for everyone? Of course not. But that decision should be for consumers to decide, not the U.S. Senate.

The post Short-Term Medical Insurance Makes the News Again appeared first on Show-Me Institute.

Rate proposals released Friday by the Missouri Department of Insurance are on average 36 percent to 42 percent higher than rates for similar 2017 plans….

Both Cigna and Anthem Blue Cross Blue Shield, the two companies returning to sell on the marketplace, listed the uncertainty about cost-sharing payments that help consumers cover the cost of insurance as justifications for their proposed rates.

Cigna has reportedly asked for up to a 73% price hike on at least some of its plans. Meanwhile Anthem will be dropping out of at least 17 counties in the state where the company marketed plans just this year. KCUR has a good national map of the number of insurers in each county in 2018. Particularly in Missouri, the map tells a story of an individual insurance market that for hundreds of thousands is less a market and more a monopoly, duopoly, or oligopoly. 

American health care reforms should be based on good policy that empowers people, not government. And these rate hikes are just the latest example of what happens when the center of a health care system is government and its cronies rather than patients themselves. We need change, and we need it sooner rather than later.

The post Ouch–Missouri Individual Health Insurance Premiums To Rise by Double Digits in 2018 appeared first on Show-Me Institute.

As we have noted before, rural areas of Missouri were already severely underserved by the Obamacare exchanges, and the departure of Blue Cross Kansas City will leave dozens of counties with no Obamacare providers next year if nothing else changes. To give our readers a sense for what part of the state the insurer covered, BCBSKC’s 2017 service map in the exchanges is below:

This may only be the first major insurer departure from Missouri that could happen this year. More on this story as it evolves.

The post Breaking: Blue Cross KC to Leave Obamacare Exchanges appeared first on Show-Me Institute.

Regarding the company’s individual commercial medical coverage (Individual Commercial), substantially all of which is offered on-exchange through the federal Marketplaces, Humana has worked over the past several years to address market and programmatic challenges in order to keep coverage options available wherever it could offer a viable product. This has included pursuing business changes, such as modifying networks, restructuring product offerings, reducing the company’s geographic footprint and increasing premiums.

All of these actions were taken with the expectation that the company’s Individual Commercial business would stabilize to the point where the company could continue to participate in the program. However, based on its initial analysis of data associated with the company’s healthcare exchange membership following the 2017 open enrollment period, Humana is seeing further signs of an unbalanced risk pool. Therefore, the company has decided that it cannot continue to offer this coverage for 2018. [emphasis mine]

What does Humana’s decision mean for Missouri? Well for starters, in 2018, Jasper, Greene, and Newton counties will likely have only one insurance provider on the exchange, assuming Anthem doesn’t leave (as they’ve hinted they might do) and make that number zero. Options in Jackson and Clay counties in the Kansas City area will also be reduced, from three insurers to only two. To be clear, Humana wasn’t the largest provider of exchange plans by a long shot, but its departure suggests its suboptimal risk pool will migrate to the remaining plans in the state’s exchange, threatening those business models, as well. If, as Humana suggests, the company’s risk pool was too sick to be sustainable as a business model in 2017, it’s reasonable to believe that the remaining exchange providers will see their pools become sicker in 2018, and thus their business models less profitable. In other words, it’s an insurance death spiral.

Below is the insurer count map that I published earlier this year. The difference in 2018? The southwest corner of the state has only one inurer, and in the Kansas City area, all the 3 insurer counties become 2 insurer counties.

Assuming the accuracy of Humana’s release, the plans listed below will not exist on the Missouri insurance exchange next year. 

The failure of the exchanges only serves to reaffirm that the misnamed Affordable Care Act needs to be repealed and replaced with a plan that empowers people and leverages the market to make care more affordable and accessible. We have a few ideas about how to make that happen. It’s time to finally make progress for patients.

The post Humana Announces 2018 Departure from Exchanges appeared first on Show-Me Institute.

Well, it's not even 2017 yet, and one of the BCBS companies is giving Missouri health insurance customers something to dread in 2018.

In other words, Missouri insurance customers are already at risk today… and may be at even greater risk in the very near future, especially if Anthem exits as it's contemplating.

There are ways to make health care in this country more affordable and accessible, but unfortunately, Obamacare isn't that solution. It's time to try something different.

The post And Now Anthem Floats Possibility of Leaving the Exchanges appeared first on Show-Me Institute.

• Mouse over individual counties to see their prices.
• There are tabs in the upper left corner that let you scroll through the different plans—Gold, Silver, Bronze and Catastrophic—and their prices. I encourage you to cycle through them, because the maps for each plan level are different.
• For easier viewing you'll also find in the lower right hand corner a "full screen mode."
• Where counties are blue and have no prices, that means that, according to the data released, there will be no plan of that type available in that county in 2017. 

The post Maps: Average Insurance Exchange Rates in Missouri, By County appeared first on Show-Me Institute.

The post Chart: 2017 Obamacare Premiums in Your County appeared first on Show-Me Institute.

On Thursday the President more or less confirmed this, albeit unintentionally. Many of our readers are aware that tech giant Samsung has recalled its Galaxy Note 7 cellular phone because it's, well, exploding. In response, the company has told Note 7 owners to stop using the device immediately. Even the FAA has banned taking such phones aboard airplanes because of the risk associated with the phone catching fire. Rather than try to upgrade the product to avert their catastrophic failures, Samsung is now… replacing all of the devices.

I had not previously thought to compare Obamacare to a device with an unadvertised tendency to explode, but luckily President Obama just painted that picture for us.

Obama compared problems in the law to a bug in new technology. He said, for example, that a company will fix a problem with a smartphone.

"They upgrade it, unless it catches fire and then they just pull it off the market," Obama joked, in a reference to the recalled Samsung Galaxy Note 7 smartphone. "But you don't go back to using a rotary phone. You don't say, we're repealing smartphones."

Along with the joke being a tad tone deaf given the pain the law has put families through, President Obama's analogy is imperfect because by repealing the PPACA we wouldn't be repealing "health care"—just an indisputably broken part of it. As Samsung is swapping one failed product for another that won't set your hair on fire, so should policymakers fundamentally reassess and replace what was and is an ill-conceived health care law that doubled-down on the status quo rather than reforming it.

As the President suggests, sometimes trying to "upgrade" an inferior product can be downright dangerous. After 6 years of poor Obamacare results, it's time for policymakers to move on to something better.

The post Like an Exploding Cell Phone, Obamacare Should Be Replaced appeared first on Show-Me Institute.

The post Think Fewer Insurers is Bad? Wait Until We Have Just One. appeared first on Show-Me Institute.

Missouri doesn’t have a “cooperative” plan, but it does have what amounts to for-profit equivalents experiencing adverse selection problems nearly identical to those of the co-ops. How are these Missouri insurance plans dealing with these financial problems? Rate hikes, of course.

New data for the 37 states that use the federal HealthCare.gov marketplace, rather than run their own exchanges, suggest that premiums for next year will be going up far more in the Kansas City area than in many other large cities.

The monthly premium for the benchmark silver plan will increase by an average of 6.3 percent for the 30 cities included in the new data from the Department of Health and Human Services. But in the Kansas City area, premiums for that plan will jump by 20.1 percent next year.

. . . Rates appear to have escalated in Kansas City because Coventry, which had the second-lowest-priced silver plan this year, raised its rates for 2016 by an average of more than 25 percent, said Ron Rowe, vice president for sales of Blue Cross and Blue Shield of Kansas City.

Simply telling people they have coverage is not the answer to America’s health care policy problems—a fact the ever-growing list of failed and failing Obamacare insurance plans bears out. Until we get a handle on the cost of health care as a country, it will be very difficult to substantively guarantee access to care to the people who need it most, whether in the private market or in a welfare program like Medicaid. We can, and must, do better.

The post Kansas City Obamacare Insurance Premiums Expected to See Double-Digit Hike appeared first on Show-Me Institute.

Well, it’s 2015, and of the 23 co-ops created, ten have already shut their doors. As PBS News Hour reports, the failure of the cooperatives came down to dollars and cents.

They had basically had solvency issues, financial solvency issues.

If they were the lower price point, that tended to attract sicker beneficiaries. That would drive up their costs. They had anticipated fairly large payments from the federal government to help offset the cost of those sicker folks.

But, of course, as we mentioned earlier, there was a change and their funding was cut early on in inception of the co-ops. And then, secondly, there was another legislative change that adjusted the amount of money that the federal government could pay them.

So the cooperatives attracted enrollees whose health was (in general) poorer and who couldn’t pay very much—a disastrous mix for an insurer—and then the cooperatives couldn’t survive after the government refused to give them the bailout they were expecting.

We’ve said it before, but it bears repeating: coverage is not care, and that fact is especially salient in the case of these cooperatives. Indeed, these government programs are failing the very vulnerable beneficiaries who they were specifically designed to attract. There are other, better ways forward on health care policy. More government is not the way.

The post Government-Run Obamacare Co-ops Begin Their Downward Spirals appeared first on Show-Me Institute.

But the pain may not hit customers in the price tag alone. Indeed, many Obamacare insurance purchasers are subsidized by the government on the basis of their income, meaning that even when the price of insurance goes up, those consumers usually don't bear the brunt of the hike—the taxpayers subsidizing them do.

At least, that's how it's supposed to work.

According to an update on Obamacare that the IRS recently sent to Congress, out of the 4.5 million taxpayers who got Obamacare's "advance payment" subsidies last year, only 2.7 million had filed the required tax forms as of the end of this May.

The rest filed for an extension (360,000), haven't filed at all (710,000), or didn't submit (760,000) the new ObamaCare form—Form 8962—that's required to make sure they got the right subsidy amount.

These 1.8 million taxpayers actually represent 2.8 million individuals, according to the IRS, because one taxpayer can file on behalf of his or her spouse and children.

In other words, taxpayers who have not filed the proper paperwork for their subsidies—or those whose income has moved them out of the subsidy range—might not only lose that money next year, but also have to return subsidies they have already received incorrectly. And in case you were wondering whether the government would really demand subsidy money back, rest assured: it's already happening. Not only could subsidized consumers see hikes in their insurance rates for insurance they're now forced to buy, but they could suddenly experience those costs without the financial insulation that had been provided to them by the government. 

Rather than simplify America's already complicated health care system, Obamacare made it even more complex, and that hurts the poor and those unaware of how this Rube Goldberg–style law operates. That complexity could lead to a new round of negative financial consequences for millions of Americans in the months ahead.

The post Tax Man Cometh: Obamacare Subsidies Pose Risk for Millions of Tax Filers appeared first on Show-Me Institute.

The post Supreme Court Rules Against King v. Burwell Plaintiffs appeared first on Show-Me Institute.

If you’re short on time, however, the case deals with what happens when a state declines to set up an insurance exchange under Obamacare, forcing the federal government to do so instead. Here’s the big question in King: Does the Affordable Care Act (ACA) block federal subsidies from going to insurance plans purchased in government exchanges that were not, as the law says, “established by the State”? If the answer is yes, it could simultaneously take subsidies away from millions of insurance plans and protect millions of taxpayers from the law’s mandates. It’d be a body blow to the law.

Why would Congress condition subsidies on states building their own exchanges? The answer is reasonably straightforward: Congress didn’t want the burden of creating exchanges to be on the federal government—that is, Healthcare.gov—and thought offering the subsidy as a carrot would get states to do the heavy lifting. Congress never thought the federal government would be running the exchanges for basically two-thirds of the country, as it’s doing today. Healthcare.gov’s rollout disaster was part and parcel of this miscalculation by Congress.

Supporters of Obamacare now contend the “established by the State” language was a drafting error, but there is lots of evidence that runs against that claim. The state exchange “carrot” strategy had appeared in prior, contemporaneous bills that were combined to form the ACA—suggesting that at least some legislators were well aware of the system they were creating. In fact, in the years that followed, Obamacare architect Jonathan Gruber famously repeated what the consequences of states not building their own exchanges would be:

With most states declining to create their own exchanges, the Internal Revenue Service then wrote rules that would extend the federal subsidies not only to exchanges “established by the State,” but also to federal exchanges. The problem is that since the federal subsidies are the basis for penalties that, thanks to the IRS, would suddenly apply to tens of millions of Americans in states that didn’t create exchanges, those subsidies could be an illegal tax. Thus, we have the King litigation.

After Wednesday’s oral arguments, we’ll likely see a decision handed down on the case sometime this summer. How will it turn out? We’ll keep you posted.

The post King v. Burwell: A Quick Preview appeared first on Show-Me Institute.

Our new county-by-county analysis was led by Yegeniy Feyman, who compiled the county-based data for 27-year-olds, 40-year-olds, and 64-year-olds, segregated by gender. We were able to obtain data for 3,137 of the United States’ 3,144 counties….

Among men, the county with the greatest increase in insurance prices from 2013 to 2014 was Buchanan County, Missouri, about 45 miles north of Kansas City: 271 percent. Among women, the “winner” was Goodhue County, Minnesota, about an hour southwest of Minneapolis: 200 percent. Overall, the counties of Nevada, North Carolina, Minnesota, and Arkansas haven experienced the largest rate hikes under the law.

Amazingly, that 271 percent figure conceals something else about Buchanan that is just jaw-dropping. If you use Forbes’ national rate navigator, you discover that a 27-year-old man in Buchanan County can expect an individual insurance policy rate increase of — get this — 411 percent.

This is “affordable”? How can any politician tell his or her constituents with a straight face that Obamacare is working, or that we need to help the Feds implement this disaster in Missouri? Missouri needs market-based insurance reforms, not Obamacare and its Medicaid expansion. Our people deserve better than this raw deal.

The post Thank Obamacare: Buchanan County, Mo., Tops List For Insurance Rate Hikes On Men appeared first on Show-Me Institute.

The disastrous rollout of HealthCare.gov may have another serious problem: A CBS News analysis shows that in many of the 15 state-based health insurance exchanges more people are enrolling in Medicaid rather than buying private health insurance. And if that trend continues, there’s concern there won’t be enough healthy people buying health insurance for the system to work….

CBS News has confirmed that in Washington, of the more than 35,000 people newly enrolled, 87 percent signed up for Medicaid. In Kentucky, out of 26,000 new enrollments, 82 percent are in Medicaid. And in New York, of 37,000 enrollments, Medicaid accounts for 64 percent. And there are similar stories across the country in nearly half of the states that run their own exchanges.

So the exchanges, billed as a private market solution to America’s health care problems, appear to be putting more people into a long-broken government program than into private insurance. That’s a huge contradiction in policy and puffery that undercuts the entire law. What assurances do taxpayers have that individuals aren’t being improperly added to the Medicaid program? And why would any legislature expand Medicaid just as Obamacare is boosting the program’s cost to the states?

The post Uh Oh: Are The Exchanges Goosing State Medicaid Rolls? appeared first on Show-Me Institute.

Twenty North Dakotans have enrolled for health insurance through the new federal health exchange, according to figures from the three North Dakota companies offering coverage on the marketplace.

The online marketplace at healthcare.gov, where health insurance is sold, is a key aspect of the health insurance law signed by President Barack Obama commonly known as Obamacare. It has been plagued by traffic issues and widespread glitches since it went live about three weeks ago.

So far, there have been no reports of the enrollment numbers in Missouri, at least to my knowledge. I have reached out to the insurers who are in the Missouri exchange and hit a brick wall when it comes to actual numbers. HHS records suggest there are technically four insurance providers in the Missouri exchange: two affiliated with Blue Cross Blue Shield, and two affiliated with Coventry. (Because affiliates don’t really compete with one another, consumers are effectively left with only two insurer options in each county, in general.) Both Blue Cross affiliates — Anthem Blue Cross and Blue Shield, and Blue Cross and Blue Shield of Kansas City — said that they will not be releasing their numbers. I have yet to receive a return call from either Coventry affiliate.

While we wait, the email I received from Anthem is below. It pretty well summarizes the position of Blue Cross.

Anthem Blue Cross and Blue Shield in Missouri’s parent company has just begun to receive confirmation of enrollment in the federal exchanges from CMS. Although it is too soon to provide Missouri enrollment details at this time, we have seen unprecedented call volumes and heavy web traffic for our exchange plans which is consistent with the experience reported by some state exchanges. We believe consumers will continue to be attracted to our trusted brand name and quality product offerings on the exchanges.

Deb Wiethop
Communications Director
Anthem Blue Cross and Blue Shield in Missouri

Naturally, “volume” and “web traffic” aren’t “enrollment,” so it looks like the actual enrollment figures will remain unknown. Why insurers are so unwilling to release the numbers is a subject of considerable speculation, but if Thursday’s movement toward a delay of the individual mandate is any indication, North Dakota’s enrollment experience may not be unique.

The post How Many Missourians Have Gotten Coverage Through The Exchange? Insurers Keep Mum appeared first on Show-Me Institute.

Plans in the Marketplace are primarily separated into 4 health plan categories — Bronze, Silver, Gold, or Platinum — based on the percentage the plan pays of the average overall cost of providing essential health benefits to members. The plan category you choose affects the total amount you’ll likely spend for essential health benefits during the year. The percentages the plans will spend, on average, are 60% (Bronze), 70% (Silver), 80% (Gold), and 90% (Platinum). This isn’t the same as coinsurance, in which you pay a specific percentage of the cost of a specific service.

Keep in mind that if you qualify for subsidies, this spreadsheet will only provide the pre-subsidy cost to you. Also keep in mind that the data the government has made available only has very broad categories; consider these your ballpark estimates for what your plan would actually cost.

In my case, the most comparable plan in the marketplace to the one I have now is nearly twice the price. That would also be the price I’d pay, because I don’t qualify for subsidies.

Happy hunting.

Note: Pricing is for monthly premiums. As you peruse those premiums, the columns proceed in this order: Premium Adult Individual Age 27, Premium Adult Individual Age 50, Premium Family, Premium Single Parent Family, Premium Couple, Premium Child.

The post Looking For (Broad) HealthCare.Gov Pricing For Missouri? We Have It appeared first on Show-Me Institute.

The time for enrolling in health exchanges is now upon us. Recent polls show that the majority of Americans continue to disapprove of the health care law — the Affordable Care Act, commonly referred to as Obamacare — enacted in 2010. But how many of us really understand what we can expect and what we will pay for this “affordable” health program? The simple fact is that most of us are just plain bewildered, not knowing how the controversial law will affect us.

A September 2013 USA Today/Pew survey provides some evidence on this. Of those surveyed, only one-quarter believed that they had a very good understanding of what the law’s impact would be on them and their family. When asked what the impact of the law would be on them in the future, over 40 percent thought it would have a mostly negative effect. Only one-in four thought it would have a positive effect.

How the law affects us is becoming clearer, sort of.  The Kaiser Health News reported that Obamacare affects treatment choice for many patients in eastern Missouri. This is because policies offered by Anthem BlueCross BlueShield, made available through Missouri’s online insurance marketplace, would not include Barnes-Jewish Hospital, or St. Louis Children’s Hospital. As reported in this newspaper, subsequent reporting revealed that BJC Healthcare will be part of another insurer, Conventry. Even with that mystery solved, just which services will or will not be covered under the new plan remains uncertain.

There also are broader negative economic affects that will arise from implementing the new law. What are the tax consequences that the average individual will face? How will these tax changes affect decisions to work?

Answering such questions is the purpose of a recent study by University of Chicago economist Casey Mulligan. (Read Mulligan’s New York Times article, “Health care inflation and the arithmetic of labor taxes“) The basis for his research is the observed fact that policies that raise taxes on your income reduce your incentive to work more. You may need to work to pay the bills, but your incentive to work a second job or someone in your household to take on a part-time work is reduced at a higher tax rate. The after-tax income may simply not be enough to induce you to work.

Mulligan’s study finds that implementing Obamacare will create significant implicit and explicit tax increases that negatively affect the decision to work for many individuals. One avenue for these higher taxes is through employer tax penalties. It also comes through higher taxes on individuals. Mulligan estimates that, on net, “all provisions combined raise marginal tax rates in 2015 by 10 percentage points of total compensation” for about half of the nonelderly adult population.

In other words, under Obamacare a large portion of the working population will experience a significant increase in their effective tax rate. And this increase comes on top of existing tax rates. The disincentive to work is larger under Obamacare than currently exists.

Mulligan’s analysis explores the labor market effects of Obamacare by considering the new, higher implicit tax on full-time work. That is, many individuals currently working full time would find it economically advantageous to shift to part-time, given the provisions of the law. “Some middle-class workers,” Mulligan writes, “will find that they can work substantially less [fewer hours] without losing any disposable income.” That is not a recipe for improving prospects for greater economic growth.

Obamacare will disrupt markets for medical care, forcing individuals to choose hospitals and doctors that they would not have chosen otherwise. Obamacare also will create substantial negative incentives for many individuals to work.

As an increased proportion of the population moves into retirement, this puts increased pressure on government social programs such as Social Security, Medicare, and now health care.

The tax increases under Obamacare will reduce the labor force as people opt out of working by retiring or they chose to work fewer hours.  Either way, the growth of output slows and with it income.

Since income funds Social Security and Medicare and now Obamacare, to fund these programs at existing levels — and with even more individuals enrolled in retirement programs — it puts strains on those still working, which is a shrinking proportion of the population.

Unless you cut back on existing programs (coverage, services, etc.) and/or raise taxes on those employed, there simply is not enough inflow of funds in out years to pay for all of these programs at current levels of coverage.

The disincentives created by the Affordable Care Act decrease the likelihood that the economic growth will rebound any time soon.

Rik Hafer is a distinguished research professor in the Department of Economics and Finance at Southern Illinois University Edwardsville and a scholar at the Show-Me Institute.

The post Obamacare: Less Choice, Higher Taxes, Slower Economic Growth appeared first on Show-Me Institute.

The takeaway: Rates will rise in 2014, and by a heck of a lot for some people in the state. A quick analysis of the data by Avik Roy, of the Manhattan Institute, finds that for a 27-year-old man in Missouri, rates for the least expensive “Bronze” plan will be 104 percent more expensive — more than twice the price of the cheapest plan available today. For a 27-year-old woman, that same plan will be 29 percent more expensive than what they’re paying today. For a 40-year-old man, the cheapest plan will spike 109 percent; for a 40-year-old woman, that plan will spike 35 percent.

About the “lower than projected” talking point: The report couches its findings as a positive — that insurance rates in the “Affordable Care Act” (ACA) exchanges will come in “lower than projected.” Both the methodology and claim are dubious, reeking more of desperation politics than academic research. The HHS compared 2014 rates to an HHS-readjusted prediction from the Congressional Budget Office about insurance rates . . . for 2016. Ignored is the sticker shock of going from today’s on-average lower rates to the dramatically higher rates of the exchange. Take all that together, and voila! The new ACA insurance plans kinda sorta sound cheaper. Also, pay close attention to the news outlets that say insurance rates will be “lower” based on this report; either they didn’t read the report, or they’re willfully misrepresenting the facts to their audiences.

The HHS report is really, really bad news for consumers, despite how you may have seen this news portrayed so far. More to come.

The post HHS Report Confirms: Insurance Rates In Missouri Exchange To Rocket Upward appeared first on Show-Me Institute.